Epidurals & Foleys

[RNBelle]

Just curious about what nurses do for pt's with epidurals. Do you give them foleys or straight cath them? One place I was everyone with an epidural got a foley and this new place they straight cath. What is best practice?

[smithtip]

When I did my clinical rotations - the facility put foleys in for epidurals without many questions asked.

The smaller facility I now work at does straight caths. We try and get the patient to go to the bathroom right before the epidural and they generally don't need cathed much if at all depending on how much longer their labor progresses. I've also seen nurses offer a bedpan if the urge is there, but often it isn't. Our facility also has a policy in affect that if a foley cath is being inserted that a urine specimen must be collected to do a u/a to determine if an infection is present before the insertion of a foley to try and rule out if a foley is causing an infection.

[SmilingBluEyes]

It really depends; if a patient receives her epidural early in labor, she gets a foley catheter (and most do elect for their epidural early). If it's later----near transition, I hold off and straight cath or let the dr straight cath just prior to delivery. It also depends on how much she has voided prior to her epidural and how much IV fluids she has had.......

I would rather place a foley than cath more than once in labor. So would the nurses where I work and that is the OB's preference, too.

We empty the foley bulb when the mom is pushing, so it does not come out of her urethra, bulb intact. If it remains, we re-inflate when done. If not, it's out and we attempt to get her up to void ASAP when the legs are working.

[SmilingBluEyes]

ALSO: "best practice" includes what your policies do state. Good luck.

[mom2michael, MSN, RN, NP]

We do Foley's and the reason is introducing a straight cath multiple times sets the patient up for multiple exposure to infections. Foley removed right before delivery, epidural off right after delivery and as soon as the patient feels her legs, up she goes to the potty.

[BirthCenterRN]

Same as smiling blue eyes

[hrobrnc]

same as mom2micheal

[jenrninmi, MSN, RN]

We straight cath where I work.

[ScubaLvr]

Where I work, we recently transitioned from using foleys right after an epidural to only straight caths. The OBs are adamant about it. They refuse to order it and we took it off our standard orders sheet. I guess evidence based "stuff" apparently shows more infections with foleys and now with Medicare refusing to pay for hospital accuired UTIs.....

there you go!!!

[cassioo, RN]

Where I work we put in a foley after the epidural and take it out when ready to push. where I was per diem it was I&O sometimes multiple times. Have a travel job starting next week 600 miles away so we'll see what they do there

[L&DRN03]

Where I work, we recently transitioned from using foleys right after an epidural to only straight caths. The OBs are adamant about it. They refuse to order it and we took it off our standard orders sheet. I guess evidence based "stuff" apparently shows more infections with foleys and now with Medicare refusing to pay for hospital accuired UTIs.....

there you go!!!

I would think straight cathing multiple times vs. an insertion of one foley would be a bigger UTI risk.

[NurseBlueEyesRN]

We generally do foley's...but if the pt is getting a late epidural, I'll try to her void before and just monitor for bladder distention and straight cath as necessary. Once they begin pushing, we remove the foley, and then we straight cath every 2 hours if we need to...